Trepanation to treat a head wound: a case of neurosurgery from 13th century Tuscany

During the archaeological excavations conducted in the 13th century cemetery of the Church of S. Agostino in Poggibonsi, Tuscany (Italy), a skull with evidences of neurosurgical intervention was brought to light. The skull, belonging to an adult male, shows two traumatic lesions produced by bladed instruments. The first lesion, located on the anterior part of the parietal bones, involved only the outer cranial table; bone remodeling indicates that the individual survived the injury for a long time. The second lesion, located on the frontal bone, involved all the thickness of the bone; the absence of reparative processes allows a diagnosis of peri mortem lesion. In order to treat this wound the patient was submitted to a surgical intervention. In fact, in correspondence to the lesion, an oval bone loss, with clean and well-defined cutting-edges, can be interpreted as the result of a trepanation, probably performed to clean the wound and to remove any bone splinters. Half of the bone "rondella" was found in situ; it can be hypothesized that the surgeon decided to replace the bony piece to protect the brain. However, the surgical intervention failed and the patient died soon afterwards. Trepanation for the treatment of cranial traumas is described by several medical classical and medieval Authors, whose texts were available in the 13th century. This case represents a rare Middle Ages evidence of neurosurgery practised to treat a bone injury.